Selahattin Katar

Clinical and Cranial Magnetic Resonance Imaging (MRI) Findings of 21 Patients With Serious Hyperbilirubinemia

This study aims to compare neurological examination and cranial magnetic resonance imaging (MRI) findings in patients with serious hyperbilirubinemia. Twenty-one serious hyperbiluribinemic term neonates (6 girls, 15 boys) who underwent exchange transfusions were included in the study. Neurological examination findings, body weight, age at admission, blood culture, urine culture, urine analysis, C-reactive protein, thyroxine, thyroid-stimulating hormone, total and indirect bilirubin levels, causes of hyperbilirubinemia (blood group typing, glucose-6-phosphate dehydrogenase, blood smear, tandem mass), treatment and duration of follow-up, auditory test results, and cranial MRI findings were evaluated. All patients were term neonates with an average body weight of 2943 ± 533 g. The mean age at admission was 4.47 ± 2.22 days, and the mean bilirubin level was 35.0 ± 10.8 mg/dL. Exchange transfusion was performed once in all, except 4 patients who needed 2 transfusions. Kernicterus findings were found in 76% of patients on neurological examination, and cranial MRI detected a pathological finding in 71% of patients. In 2 patients, cranial MRI showed kernicterus findings, despite normal neurological examination. In contrast, in 3 patients, despite kernicterus findings in neurological examination, cranial MRI was normal. Although cranial MRI has an important place in the diagnosis of kernicterus, it does not always correlate with clinical findings. We believe that studies with larger series are warranted.

Childhood idiopathic nephrotic syndrome in Turkey

Background : It has been reported that there are racial and regional differences in peak incidence age, histopathological features and response to steroid therapy in childhood idiopathic nephrotic syndrome.

Does albumin and furosemide therapy affect plasma volume in nephrotic children

Abstract Albumin infusions transiently increase plasma volume (PV) and oncotic pressure, and may restore diuretic responsiveness in nephrotic edema. To determine if albumin and furosemide therapy have an effect on PV in nephrotic children, 14 severely edematous children with minimal change nephrotic syndrome were evaluated with standard clinical parameters (heart rate, blood pressure, body weight, pretibial edema, abdominal circumference) and echocardiography [inferior vena cava index (IVCI), inferior vena cava collapsibility index (IVCCI)] before, 1 h and 24 h after albumin (20%, 0.5 g/kg, 1 h) and furosemide (2 mg/kg, IV) therapy. An increase in IVCI (P<0.05), decrease in IVCCI (P<0.05), edema (P<0.005), and hematocrit (P<0.005) were statistically significant 1 h after albumin and furosemide therapy, with a transient effect 24 h later. Body weight (P<0.005), abdominal circumference (P<0.05), and edema (P<0.005) decreased significantly at 24 h. It is concluded that albumin and furosemide therapy increases PV transiently in nephrotic edema, returning to baseline values at 24 h with a decrease in body weight, abdominal circumference, and edema.

Diameters of normal thoracic vascular structures in pediatric patients

PurposeTo determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference.MethodsContrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated.ResultsThere was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent.ConclusionsDiameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.

Horseshoe lung associated with rare bilateral variant of scimitar syndrome: demonstration by 64-slice MDCT angiography

Scimitar syndrome with bilateral abnormal venous drainage and horseshoe lung is extremely rare. These rare complex anomalies were diagnosed in a 5-year-old boy by 64-slice multidetector CT (MDCT). This technique provides high-quality visualization of vascular, bronchial and parenchymal structures in a single session, such that no further invasive techniques are required. One obvious disadvantage of MDCT is the radiation exposure, especially in paediatric patients. The use of a single phase of contrast material administration reduces radiation exposure. The workstation platforms of MDCT systems allow multiplanar 2-D and 3-D postprocessing. As a result, various complex pathologies, such as that discussed here, can be diagnosed following a single imaging session with a certain precision.

Henna causes life‐threatening hyperbilirubinaemia in glucose‐6‐phosphate dehydrogenase deficiency

The crushed leaves of henna are used as a cosmetic agent all over the world, particularly in the Middle East. Following its application, it causes a red-brown colouration of the skin. Lawsone (2-hydroxy-1,4 naphthoquinone) is a chemical present in henna. Percutaneous application of henna is known to cause haemolysis in blood cells deficient in glucose-6-phosphate dehydrogenase (G6PD). We report a case of a child who developed hyperbilirubinaemia after application of henna. A 7-day-old boy, who had been previously well, was admitted to our hospital with a 29-hour history of mild pallor and jaundice. Henna had been applied topically for prevention of nappy rash and for traditional cosmetic purposes. Jaundice, lethargy and mild pallor had developed within 29 h following henna application. The patient had been born at 38 weeks of gestation in hospital, and had cried immediately after birth. He had been breastfed, and no vaccines had been administered. On admission, findings were as follows: weight 3280 g, length 520 mm, head circumference 36 cm (50th percentile), axillary temperature 36.7 C, blood pressure 57 ⁄ 35 mmHg and heart rate 148 beats ⁄ min. General appearance was poor. He was hypoactive and very icteric. Approximately 50% of the skin surface had the red-brown colour typical of henna application, including both lower extremities and the plantar areas of the feet (Fig. 1). Abnormal relevant laboratory investigations were haemoglobin 12 g ⁄ dL [normal range (NR) 13–20], platelets 490 · 10/L (NR 150–450), total bilirubin 62.7 lmol/L (NR > 20.5) and indirect bilirubin 58.5 lmol/L (NR > 20.5). On peripheral smear, the proportion of normoblasts was 13% and reticulocytes 7%. Anisocytosis and fragmented erythrocytes were present. A sickling test was negative. Screening revealed G6PD deficiency. Urine analysis was positive for protein, bilirubin and haemoglobin. Both the patient’s and the mother’s blood group was A Rh+, and direct Coombs’ test was negative. Because of the patient’s high serum indirect bilirubin level, exchange transfusion was performed immediately, and intensive phototherapy was then administered. Despite an initial decrease, serum bilirubin level (SBL) again increased to 33 mg ⁄ dL after 12 h, thus a second exchange transfusion was performed. After 36 h of phototherapy, SBL reduced to 8 mg ⁄ dL. Follow-up examinations did not reveal any residual jaundice or any sign of kernicterus. G6PD is required for the generation of the reduced form of nicotinamide adenine dinucleotide phosphate (NADPH), which maintains glutathione in the reduced form to counteract the day-to-day oxidant stresses on PD

Infantile iatrogenic Cushing's syndrome.

High potency or/and extended use of topical corticosteroids, particularly in children, may cause suppression of the hypothalamopituitary-adrenal axis. However, iatrogenic Cushings syndrome in infantile age group is very rare and only a few patients have been reported to date in the literature. Here, we report a case of iatrogenic Cushings syndrome in a 6-month-old male child whose parents have admitted to the hospital for overweight and skin fragility.

Naloxone use in a newborn with apnea due to tetrahydrozoline intoxication.

Tetrahydrozoline is an imidazoline compound found in over-thecounter eye drop solutions and nasal decongestants. The ingestion of even small doses of topical imidazolines can lead to significant morbidity. It may cause lethargy, hypotension, bradycardia, respiratory depression and coma. In the present report we describe the first newborn case of symptomatic tetrahydrozoline ingestion in which the clinical signs and symptoms were reversed with naloxone.

An Unusual Cause of Gastrointestinal Bleeding and Severe Anemia in a Child: Leech Infestation

A 1-year-old boy with epistaxis, gastrointestinal bleeding and severe anemia that caused cardiorespiratory distress presented to our unit. The results of coagulation tests were normal. An erythrocyte suspension transfusion was given to the patient. On the second day of his hospitalization, a leech was removed from his nose. In developing countries, leech infestation should be considered in cases where epistaxis, hematemesis, gastrointestinal bleeding and severe anemia are of unknown origin.

Evaluation of brainstem auditory evoked response audiometry findings in children with tuberculous meningitis at admission

OBJECTIVE To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission. METHODS Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I-III, III-V, I-V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected). RESULTS The latencies of interpeak intervals (except III-V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four ears. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s. CONCLUSION Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery.